Certificate



Patented Aug. 29, 19252.

2 SHEETS-SHEET l.

MASON.

MIIIIIIIIII M ,IIIIIIIIIII II II m CERTIFICATE. APPLICATION FILED Auaa, 1918.

IIII II zo \\h r INI II IIIIII 1 mgm@ E. IvI. IvIAsoN.

CERTIFICATE.

,APPLICATION FILED AuG.8, 1918.

Patented Aug. 29, )1922.v

2 SHEETSf-SHEET 2.

um @ANI IIIIIIIIIIIIIIIII Ts" are EDWIN MEA'HLON MASON, OF CRA'W'FORDSVILLE, NDANA, ASSGNOR TO THE SUPREME TRIBE OF BEN 'HUR, OF GRAWFORDSVILLE, INDIANA.

` CERTIFICATE.

instaan,

To all whomv t may concer/a: l

Ee it known that l, Enwin M. Mason, Aa citizen of the United States, residing at Crawfordsville, in the county of Montgom ery and State of indiana, have invented a new and useful Certificate, of which the following is a specification.

This invention relates to a certificate particularly designed for use by insurance organizations, one of the objects being to provide an insurance certificate having, as an integral part thereof, a draft identifying the certificate by number and which, when the benefit becomes payable, can be cnt from the certificate, lled in with the name of the payee, endorsed, and deposited for collection.

Another object is to provide a draft of this character having, in addition to a place for endorsements, a form of affidavit to be filled out and executed by the payee, and a certificate to be filled out and signed by the proper official of the local branch of the organization with which the insured was affiliated, so that when the dra' t is deposited and subsequently presented for collection it will contain the properly verified information on which the payment of the draft is to be based.

With the foregoing and other objects in view which will appear as the description proceeds, the invention consists of certain novel details of arrangement and combinations of parts which will be hereinafter more fully described and pointed out in the claim, it being understood that various changes may be made in the construction and arrangement of the parts without clepart-ing from the spirit or sacrificing any of the advantages of the invention as set forth in the appended claim.

In the accompanying drawings the preferred form of the invention has been shown.

In said drawings Figure l is a view of the outside pages of a certificate constituting the present invention. y

Figure 2 is a view of the inside pages thereof.

Referrino` to the figures by characters of reference, 2, 3 and ddesignate the four pages of the certificate, and the terms and conditions under which the certificate is issued together with the naines of the insured and of the payee printed in the usual manby the organization.

Speci'ieationef Letters Eateiit. jllgtgmugd pagg 2Q? i922 Application mee August e, isis. seriai No. aliases.

ner upon pages l, 2 and 3, the certificate bearing the seal and the names of the proper officials of the organization. 'These features are common in many kinds of certificates and it isnot deemed necessary to describe or illustrate the same in detail.

Forming a part of the third and fourth pages of the certificate is a` draft on the insurance organization bearing the signatures of the proper officers thereof and the face portion of which draft has been indicated at 5. This draft, when printed, or before issnance as a part of the certicate, is provided with a number (shown at 6) which corresponds with the number of the certificate (shown at 7 in Figure l). The name vof the beneficiary is entered in the draft as the payee when the certificate is made out and issued. The. amount of the benefit, however, can be left blank to be filled out subsequent ly to agree with the privileges and condi tions set forth in the certificate.

rihat portion of page 4 of the certificate which is directly back of the face portion of the draft on page 3 is provided at one end with a place for endorsements, as shown at 8, and printed therebelow is a statement of the conditions under which the draft is paid Below this statement is a form of affidavit to be filled out as indi- 'ficiary, and executed before a notary public,

this affidavit being shown at 9. Below the affidavit is a certificate, 10, to be filled in and signed by the local representative of the organization, certifying to the facts set forth in the affidavit.

When a benefit becomes due, the beneficiary clips from the certificate, the sight draft forming a part thereof, fills in the amount payable under the conditions of the certificate, fills in and executes the affidavit on the back of the draft and then has the representative of the local branch fill in and sign the certificate 10. rihe draft is then endorsed and deposited for collection.

What is claimed is The combination in a single paper, of'an insurance certificate having an identifying character and a draft having a duplicate of said character, said draft adapted to be removed from the certificate and presented to a bank for payment like an ordinary draft, there being means for indicating the points along which the draft is to be separated from the certificate, said certificate containing a statement of certain conditions upon Which the payment of the insurance is dependent7 said'- conditions including' a promise to pay a definite speeiiied portion of the insurance as a death benefit immediately upon the death of the insured and without other' proof of death thanthe affidavit of the beneficiary verified by the certific'zate of the agent of' the payor, the said draft being drawn for the amount of said death benefit and payable upon the death of the insured, there being arranged upon the back of the draft7 and Within the area. to be removed from the certificateyan aflidavit and a certicate, said aidavit to lbe executed by the beneficiary prior to presentation vfor payment and setting forth that the conditions of the certificatehave been complied with, and said certificate to be signed by the agent of the payor prior to presentation of the draft for payment and vouehing for the p truthfulness of the facts in the certificate.-

In testimony that I claim the foregoing as my own, I have hereto affixed my signa- 25 .MA1-Na.. 1 i 

